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63 July 2015
63
Introduction
Case Report
A 75 year old man non-diabetic,
non-hypertensive was admitted
with the complaints of urinary
retention and constipation since
last 24 hours. There was no history
of urinary complaints in the past.
There was history of rash and
burning sensation on his lower
back and lower abdomen on
the right side, 8 days prior to
admission. He was diagnosed as
a case of herpes zoster infection at
government medical college and
was put on symptomatic treatment.
Otherwise there was no significant
Discussion
The most common presentations
were paresthesias, pain and
itching. 2 In a study conducted
on 205 patients of herpes Abdul
et al found that only 4.8% had
sacral involvement while 42% had
thoracic involvement. 1
There are three syndromes
of zoster associated bladder
dysfunction. They are zoster
cystitis, zoster retention of urine
and zoster myelitis. Retention is
caused by spread of infection from
dorsal root ganglion into the sacral
motor neurons, roots or peripheral
nerves causing interruption of
bilateral detrusor reflex to manifest
as atonic bladder. 2
Involvement of the sacral nerve
roots (S2-S4) in herpes zoster is
uncommon. The virus involves
not only the ipsilateral nerve root
ganglion but also the meninges
and contralateral root involvement
partially. Thus herpes zoster may
cause bilateral pelvic nerve root
involvement eventhough the skin
eruption is unilateral. 3
Symptoms of sacral and lumbar
radiculopathy in herpes cause
dull or tingling pain in the lower
back, buttocks or anogenital area,
sciatica-like pain down the thighs,
weakness of the lower limb and
inability to walk on tip toes. In
Associate Professor, 2Lecturer, Department of Medicine, S.D.K.S.D.C. and Hospital, Nagpur, Maharashtra
Received: 04.12.2014; Revised: 03.04.2014; Accepted: 26.05.2014
64
References
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